Shingles Flashcards
(30 cards)
What is the classic look of shingles?
Rash only on one side of the body (unilateral), affects older ppl, pain can occur before the rash appears
is chicken pox more common in children or adults?
Children
Children who have had chicken pox can get shingles when they are older
Chicken pox in children is very tolerable, shingles as adult = not so much
What are shingles?
the re-activation of chickenpox virus (10%-20% of ppl)
What could you see in a patient with shingles?
they tend to be older (50 years after the pox)
Pain is possible before the rash appears
Bumps turn into blisters over time
There will be small red blisters along nerve pathways
Blisters can break, causing oozing/crusting
What are the most common sites for shingles?
T1 to L2 vertebrae
The virus lies dormant in these nerve pathways
trunk area and lower back
What do we do if a patient comes in with no rash, but all the sx of shingles?
We can’t do anything without seeing the rash
We have to refer as beyond our scope
What do we do if we see a patient with shingles on the face?
Medical territory, need MD assessment
How long does shingles last for?
3-4 weeks
What are the treatments for acute phase shingles?
Antivirals within 72 hours of rash’s initial appearance (otherwise won’t be effective)
Analgesics - acet or NSAIDs
cool compress/ calamine for the itch
Can we put calamine on a shingles patient without a rash?
No, need the rash otherwise it will irritate the skin
Can antivirals be used on everyone with shingles?
No, they work the best if the patients are over 50 years old
We can still give it to them if they are under if they request it
How long are antivirals used for in shingles patients?
7 days
What is the 50-50-50 rule?
American academy of family physicians recommends giving the antiviral within 50 hours of the rash, to people 50 years or older, and to those with 50 or more rash lesions
Age, hours, lesions
Are shingles very common?
No, tinea is more common than shingles
Can we use NSAIDs in chicken pox, acute shingles, or chronic shingles?
We can only use NSAIDs for the zoster virus in acute shingle cases
What oral meds can be given to people under 20 years for chicken pox?
Acet for soreness -YES
ASA - No, due to Reyes syndrome
Ibu - no
Why can’t ibuprofen be used for children with chicken pox?
because it has been associated with life-threatening bacterial skin infections
Explain chronic shingles
Also known as post-herpetic neuralgia
The rash is gone, but the virus is still doin damage
The patient will experience nerve pain
Occurs in 10-15% of shingles cases
What is the treatment for post-herpetic neuralgia?
TCAs - good for nerve pain
gabapentin/Lyrica/ carbamazepine
capsaicin
What is the difference between neuropathic and somatic pain?
neuro - like hitting your funny bone, you will feel buzzing
somatic is outside damage such as banging your elbow
Are NSAID such as ibu good for neuropathic pain?
No, use acet and TCAs because they are much better
What is capsaicin? What is it good for?
It is in the same realm as rub A535
designed to irritate the skin, but it reduces substance P in nerves
Has a hospital smell to it - not well received by the public
We can’t use it for classic acute cases because the med will irritate the rash
It is for post-herpetic neuralgia only
Applied TID where the pain is
Needs constant application in order to depleted the substance P in the nerve fibers
Can you get shingles from someone with shingles? Can you get chicken pox from someone with shingles?
No; yes
What is the name of the more effective shingles vaccine? how is it administered? How long is the coverage?
The Shingrix vaccine 600$
there are 2 doses
immunity lasts for 4 years
